Before starting NIV

Testing patients with bulbar impairment

There is evidence that patients with bulbar impairment can still benefit from NIV so they should be considered for a trial.


There are extra considerations to make when carrying out respiratory function tests in patients who have bulbar impairment. Healthcare professionals should be mindful of the factors that influence the decision to carry out respiratory function tests and the difficulties gaining an accurate assessment.

Thinking point

What are some of the factors to consider when carrying out respiratory function tests in patients with bulbar impairment and how might you overcome these in your service?

Some things you should consider:

To overcome some of the concerns, there are a range of steps that you can take. These include:

In the following clip, Rosie Whitehead, a Respiratory Physiotherapist, describes the challenges you may face when determining changes in respiratory function.

Video transcript

Challenges determining change in respiratory function

Rosie Whitehead

“For some patients, it’s more difficult to know if there’s been changes in their respiratory muscles; those patients that have got a cognitive impairment and they’re not able to tell you the symptoms they’ve noticed or they’re not able to do the breathing tests effectively because they’re quite objective. So we might rely more on a capillary blood gas because that isn’t reliant on the patient reporting things.

For someone who’s got a cognitive impairment, we will rely more on family - are they quite agitated at night, have they noticed they are waking up more, noticed that they are more breathless

Someone that has got quite impaired bulbar function will struggle to do spirometry and will struggle to do a peak cough flow. But it’s looking at: have they noticed their symptoms change, have they noticed that they’re struggling more at nighttime and that might be a sign that they are getting more breathless and their respiratory muscles are weaker.

Again, using the capillary blood gas, like you would with those with a cognitive change, as more of an objective marker and relying more on that than you would the FVC and the spirometry.”

Good practice points